Fighting TB in Asia: Public and private health sector should partner up

In Asia, partnerships between public and private healthcare providers are especially relevant in the fight against tuberculosis (TB). "These partnerships can help guarantee quality of care and improve information on the national TB situations," says Giuliano Gargioni, Team Leader, Partnering and Social Mobilization at the Stop TB Partnership. Read more

In the global response to tuberculosis, all care providers need to be engaged, Gargioni stresses. "In countries like India, you see that the state sector alone will find it very challenging to reach all people, even because many persons choose to consult first with private practitioners," he says. "The private sector with nongovernmental and faith based organizations can join efforts with the national programmes to implement TB control plans. And national programmes can help mobilize resources to support initiatives of public utility that come from the non-state sector. This is the basic concept of national Stop TB partnerships."

These partnerships may be especially relevant in Asia, particularly "in places where there is even some stigma attached to the public sector and people think going there is something only the poor do," Gargioni illustrated at the sideline of the international symposium "Research and development of new tuberculosis vaccines" in Zaragoza, Spain (June 3-4). "It is important to recognize this specific situation when addressing tuberculosis issues: this means availing proper diagnosis and care based on international standards wherever people will decide to seek medical attention."

The International standards for Tuberculosis (TB) Care and certifications for private practitioners who follow them give some guarantee about the quality of their work and of their collaboration with national TB programmes, Gargioni adds. "Moreover, WHO (World Health Organization) tuberculosis epidemiological data come from case reporting by public health systems and, unless they also includes information of the private sector, might then not fully reflect the situation."

The establishment of (more) public-private partnerships can play an important role in facing these challenges, Gargioni says. "We're looking at the private sector not as a problem, but as a resource," he stresses. "If the private and public sector establish partnerships this can improve access to diagnosis for thousands of sufferers, ensure quality of care and make the data we have on the global tuberculosis epidemic more accurate."

Not only health care providers, also communities have to get more involved. "Communities could and should play a decisive role, particularly in tuberculosis detection by referring to health facilities people with chronic respiratory symptoms and supporting patients during their treatment," Gargioni says. "But communities are often completely unaware of the TB problem and not involved in a dialogue to shape successful strategies at grassroots level."

In a presentation at the symposium in Zaragoza, Gargioni presented an overview of the global achievements and challenges in TB control and research. Incidence rates are highest in Africa. "But in terms of absolute number of cases, more than half are in the Southeast Asian and Western Pacific region," he said.

Of special concern in the Asian region are drug-resistant forms of tuberculosis, which are even more difficult to treat. "Multidrug-resistant (MDR) TB is a serious problem in China and in countries of the former Soviet Union. The Indian subcontinent also shows an important role in the estimated absolute numbers of MDR cases," Gargioni stressed. "Extensively drug-resistant TB (XDR-TB) has unfortunately been detected in all countries where public health officials have looked for it."

Weak health systems are a major challenge in efforts to control tuberculosis in general, and MDR-TB in particular. "Problem number one is the crisis in the health work force. There are not enough people on the ground, to be close to where the TB patients live and make care accessible," Gargioni said, adding that more laboratories, improved infection control and more financial resources are needed as well. "If we concentrate the efforts to control MDR-TB in India, China and the Russian Federation, we can make a significant difference."

Thanks to the implementation of the DOTS (directly observed treatment, shortcourse) and Stop TB Strategy 36 million people have been successfully treated from 1995 to 2008 and more than 6 million deaths have been averted, according to WHO. But the challenges ahead remain huge. The latest WHO data show there are 9.4 million new TB cases and almost 2 million people deaths in 2008. Worldwide, almost 1,5 million people are TB/HIV co-infected, of which almost 0.5 million die every year. In 2008, there were 440,000 new MDR-TB cases and 150,000 MDR-TB related deaths.